Medicaid Managed Care Fireside Chat

Hot Topics

Thursday, February 13 | noon-1 p.m.

Please join this month's Fireside Chat on Thursday, February 13 from noon to 1 p.m., hosted by Dr. Janelle White, Chief Medical Officer of Medicaid. Topics will include:

• 1115 Waiver Renewal
• Child & Family Specialty Plan Update
• Annual Health Disparities Report
• Making Care Primary
• Clinical Pharmacy Updates
• Community Alternatives Program (CAP) Referral Process
• Collaborative Care Capacity Building Program (CoCM)

Register by clicking the blue button below.  We look forward to connecting with you!

Cardiovascular Disease is the Number 1 killer of women!

Women have been excluded from research, testing, treatment, and funding. 

Women at every age, stage and season of life need support and that's why we GO RED!

• To be SEEN
• To be COUNTED
• To be HEARD
• To MAKE AN IMPACT

On Friday, February 7, share your heart and join us as we WEAR RED together.

Learn more about Heart Disease in Women, National Wear Red Day ® and American Heart Month!

Starting October 1, 2024, the Centers for Medicare and Medicaid Services incorrectly returned certain Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) claims with reason code W7072:

• Type of bill: 017X (RHC) and 077X (FQHC)
• HCPCS code 93010 (electrocardiogram, EKG or ECG)

RHCs and FQHCs should resubmit these claims that were returned in error.

Your patients might be eligible! Two NCDHHS options to help them keep warm this winter!

NCDHHS' Low Income Energy Assistance Program (LIEAP) is a federally-funded program that provides for a one-time vendor payment to help eligible households pay their heating bills.

While households including a person aged 60 or older, or disabled persons receiving services through the NC Division of Aging and Adult Services were eligible to sign up in the month of December, all other households may apply now through March 31, 2025 or until funds are exhausted.

Households that meet the following criteria may be eligible:

• Have at least one U.S. citizen or non-citizen who meets the eligibility criteria.
• Meet an income test
• Have reserves at or below $2,250. (Resources will not be counted for this year's season from December 1, 2022-March 31, 2023)
• Be responsible for its heating costs.

More details about eligibility criteria

There are courses available to you on a variety of topics!

Topics for 2025 include:

Leadership, Operations Management and Quality Improvement.

Learn more and register:

The Rural Communities Opioid Response Program (RCORP)---Overdose Response is a one-year program supporting improved health care in rural areas by addressing their immediate and short-term needs related to the provision of substance use disorder services.  RCORP--Overdose Response aims to reduce and prevent the risk of overdoses in rural areas.  HRSA (Health Resources and Services Administration) will make approximately 20 rewards of up to $300,000 each.

The RCORP--Overdose Response Program will support specific, short-term substance use disorder prevention, treatment, and recovery activities, as well as work related to capacity building, supportive services, and special populations.  Allowable activities are defined in the notice of funding opportunity.

Eligible organizations include all domestic public or private, non-profit, or for-profit entities.

• A technical assistance webinar via Zoom will be held for applicants on Thursday January 30, at 2:00 pm Eastern. For more information about this funding opportunity, contact the Program Coordinator, Diana Wang, at ruralopioidresponse@hrsa.gov. 
  
  
• View the Notice of Funding Opportunity on Grants.gov and apply by March 10.

Source: HRSA.gov Federal Office of Rural Health Policy

Photo generated using AI

Everyone deserves a path to recovery from substance use disorders, and treatment can be the first step. You can make a difference in the lives of your patients. 

This could be the year you make a new difference in the lives of your patients! Whether your patient is taking a Dry January break from alcohol or working through recovery from substance use disorder long-term, every step forward counts!

Find resources to help better treat and support them: samhsa.gov/medications-substance-use-disorders/provider-support 

The NC Office of Rural Health has released Wave 2 of the Telehealth Infrastructure Grants funding opportunity! Applicants have until January 31, 2025 to apply.

Grants resulting from this Request for Applications (RFA) will enhance the accessibility and effectiveness of telehealth services throughout the state.  This RFA aims to support the development and improvement of the technological infrastructure required for delivering remote healthcare services, such as broadband connectivity, video conferencing systems, electronic medical records, and secure communication tools with a priority on independent primary care practices and Ob-GYN practices.

If your organization participates in the Aetna State Plan, we advise you to confirm your participation ahead of the January 1, 2025 launch date!

Effective January 1, 2025, Aetna will replace Blue Cross Blue Shield NC for the NC State Health Plan coverage.

Which plans are included?

• Enhanced PPO Plan (80/20)
• Basic PPO Plan (70/30)
• High Deductible Health Plan (HDHP)

This change does NOT impact members enrolled in the Humana Medicare Advantage plans.

The current pharmacy benefit manager (CVS Caremark®) will not change.

Humana Military's claim processor will switch from Wisconsin Physicians Service (WPS) to PGBA LLC, effective January 1, 2025.

Key Changes:

EDI Claims:

• The 2025 TRICARE East Payer ID is 99727

Claims and Document Submissions:

• Starting January 1, 2025, use XPressClaims via provider self-service

Clearinghouse Requirements:

• New submitters must file a Trading Partner Agreement and Enrollment Form to obtain a          mailbox/submitter ID
• Confirm Payer ID 99727 is enabled if your clearinghouse already files claims to PGBA
• If your clearinghouse does not submit to PGBA, files can be uploaded directly if they meet ANSI     X12 standards.
• Batch claims processing is available through the EDI Gateway mailbox system.
• Complete a PGBA EDI Provider Agreement to submit claims electronically

Claims with 2024 Dates of Service (DOS)

• WPS will process claims with 2024 DOS until April 30, 2025
• After April 30, 2025, submit 2024 claims via XPressClaims or the clearinghouse.
• Ensure all documentation and disputes are submitted promptly before April 30, 2025.

ERA/EFT Enrollment:

• Re-enroll in ERA/EFT by January 1, 2025 even if currently enrolled. (click 'I am staying in East Region'). 
• Note: T17 EFT/ERA applications will no longer be accepted after this date.

Source: Tricare EFT Changes Coming in 2025